Very Low Calorie Diets (VLCD) <800 Calories ( often as low as 400-500 Calories):
Any diet, regardless of its caloric level, that provides less than half of an individual's energy needs
is a VLCD for that individual. Virtually all adults have energy needs that exceed 1000 Calories a
day, and therefore any diet below 500 Calories, and for many individuals, diets below 800 calories
are VLCD. But other regimens that are higher in Calories may also be VLCD using this same rule
of thumb; for example, a 1200 Calorie diet prescribed to a man whose usual intake is 3000
Calories would also qualify as a VLCD.
Uses and Candidates for Therapy:
These diets are reserved for special uses and for individuals at high risk because of their potential
for greater metabolic effects and the consequent need for more extensive medical monitoring.
VLCD are often used when the health risks from obesity are particularly acute and threatening.
Individuals with BMI's >30 or those with lesser degrees of overweight but many comorbidities
(BMI>27 with comorbidities) and who have failed to lose weight with more conservative approaches
are candidates for therapy. Medical contraindications include recent myocardial infarction, cardiac
conduction disorder, history of cardiovascular disease, renal or hepatic disease, cancer, type 1
diabetes and pregnancy. The advantages of the VLCD for patients include a rapid improvement in
blood pressure, blood glucose, serum lipids and often-psychological status but it has been
disappointing in the long term, in part because it is difficult for individuals to maintain compliance.
Formulations Available:
The hallmarks of the VLCD are their low calorie level and relatively high percent of protein (never
less than 28% Calories and often much higher). Protein needs are elevated on VLCD. On a VLCD,
1.5 gm of high quality protein per kilogram of ideal body weight per day is desirable, with intakes
no less than 65-70 gm daily. Intakes may need to be even higher if the dieter suffers from certain
diseases or is physically stressed, since nitrogen losses may rise further in these states.
Higher protein levels may help to preserve protein nutritional status. VLCD also have, relatively low
carbohydrate levels, making them ketogenic, and extremely low fat content. Without special
formulation or supplementation, the VLCD is inadequate in several vitamins and minerals,
especially potassium, calcium, iron, zinc, vitamin B6, copper and possibly other nutrients.
There are two major types of VLCD currently in use; commercial preparations and "home made"
regimens. The commercial preparations include powdered products rich in egg or milk based
proteins that are mixed with water and consumed 4-5 times daily. The commercial products must
provide at least 70 gm by law and often contain much higher amounts of high quality protein (70-
100 gm), 50-100 gm carbohydrate, and up to 15 gm fat per day, plus vitamins and minerals in
amounts to meet the Recommended Dietary Allowances. These products are formulated under
Food and Drug Administration regulatory specifications. These products are convenient and have
a predictable and adequate composition when used as directed. Their major disadvantage
compared to home preparations is their higher cost.
The "home-made" VLCD regimens are sometimes referred to as protein sparing fasts, or protein
sparing modified fasts (PSMF). With PSMF, the protein is given in the form of either formula or
natural foods such as lean meat, fish or poultry, and a few other foods plus supplements of 2-3 gm
potassium chloride and a multivitamin/multimineral supplement in amounts approximating the
Recommended Dietary Allowances; without such supplementation they may be inadequate.
The extremely hypocaloric versions of VLCDs which are also often low in carbohydrate and sodium
promote a mild ketosis that gradually leads to a diuresis and rapid loss of weight in the first several
days on the diet.
Use:
Evaluation of general health and cardiac status is important prior to the institution of VLCD.
Physician monitoring during the regimen is also important. Many practitioners begin the regimen
with a 2-4 week LCD phase to assess ability to comply with a restrictive regimen and to begin the
weight loss process. This is followed by a 12-16 week VLCD phase; the regimen is limited to this
amount of time to avoid excessive loss of lean tissue. The VLCD phase is followed by a 4-6 week
refeeding phase of transitioning back to usual foods and gradually increasing caloric levels; this
helps to avoid rapid weight changes due to refeeding with restoration of glycogen stores and shifts
in water balance. The refeeding phase also provides a time for assisting the dieter to plan a
maintenance diet on conventional foods and to solidify a physical activity schedule. VLCD are most
effective when administered as part of a more general weight control program that includes
physical activity, nutrition education, behavioral modification and attention to decreasing other risk
factors. If additional weight loss is needed, it is recommended that several months elapse before
another VLCD phase is instituted.
Safety:
Minor physiological problems that occur even with appropriate physician monitoring of cardiac and
general health status include fatigue, dizziness (due to orthostatic hypotension), muscle cramps,
gastrointestinal distress, and cold intolerance. The risk of gallstones is increased, and seems to be
particularly high when weight loss is very rapid (e.g.>1.5 kg/week).
Effectiveness:
Because these VLCD diets are so low in energy, they usually produce a greater initial weight loss
than LCD; usually 10-25% over 12-16 weeks of treatment in randomized studies. They can
achieve 1.5 – 2.5 kg/week weight loss, with a total loss of as much as 20 kg over a 12 week period.
Levels of plasma uric acid and cholesterol tend to rise in many patients. Menstrual abnormalities
have frequently been observed. An increased tendency toward cholelithiasis (gallstone disease in
which the gallstones are abnormal, inorganic masses are formed in the gallbladder and in the
common bile or hepatic ducts) and cholecystitis (inflammation of the gallbladder because of
obstruction of the cystic duct from cholelithiasis) has been reported. The development of postural
hypotension is not uncommon.
Any diet, regardless of its caloric level, that provides less than half of an individual's energy needs
is a VLCD for that individual. Virtually all adults have energy needs that exceed 1000 Calories a
day, and therefore any diet below 500 Calories, and for many individuals, diets below 800 calories
are VLCD. But other regimens that are higher in Calories may also be VLCD using this same rule
of thumb; for example, a 1200 Calorie diet prescribed to a man whose usual intake is 3000
Calories would also qualify as a VLCD.
Uses and Candidates for Therapy:
These diets are reserved for special uses and for individuals at high risk because of their potential
for greater metabolic effects and the consequent need for more extensive medical monitoring.
VLCD are often used when the health risks from obesity are particularly acute and threatening.
Individuals with BMI's >30 or those with lesser degrees of overweight but many comorbidities
(BMI>27 with comorbidities) and who have failed to lose weight with more conservative approaches
are candidates for therapy. Medical contraindications include recent myocardial infarction, cardiac
conduction disorder, history of cardiovascular disease, renal or hepatic disease, cancer, type 1
diabetes and pregnancy. The advantages of the VLCD for patients include a rapid improvement in
blood pressure, blood glucose, serum lipids and often-psychological status but it has been
disappointing in the long term, in part because it is difficult for individuals to maintain compliance.
Formulations Available:
The hallmarks of the VLCD are their low calorie level and relatively high percent of protein (never
less than 28% Calories and often much higher). Protein needs are elevated on VLCD. On a VLCD,
1.5 gm of high quality protein per kilogram of ideal body weight per day is desirable, with intakes
no less than 65-70 gm daily. Intakes may need to be even higher if the dieter suffers from certain
diseases or is physically stressed, since nitrogen losses may rise further in these states.
Higher protein levels may help to preserve protein nutritional status. VLCD also have, relatively low
carbohydrate levels, making them ketogenic, and extremely low fat content. Without special
formulation or supplementation, the VLCD is inadequate in several vitamins and minerals,
especially potassium, calcium, iron, zinc, vitamin B6, copper and possibly other nutrients.
There are two major types of VLCD currently in use; commercial preparations and "home made"
regimens. The commercial preparations include powdered products rich in egg or milk based
proteins that are mixed with water and consumed 4-5 times daily. The commercial products must
provide at least 70 gm by law and often contain much higher amounts of high quality protein (70-
100 gm), 50-100 gm carbohydrate, and up to 15 gm fat per day, plus vitamins and minerals in
amounts to meet the Recommended Dietary Allowances. These products are formulated under
Food and Drug Administration regulatory specifications. These products are convenient and have
a predictable and adequate composition when used as directed. Their major disadvantage
compared to home preparations is their higher cost.
The "home-made" VLCD regimens are sometimes referred to as protein sparing fasts, or protein
sparing modified fasts (PSMF). With PSMF, the protein is given in the form of either formula or
natural foods such as lean meat, fish or poultry, and a few other foods plus supplements of 2-3 gm
potassium chloride and a multivitamin/multimineral supplement in amounts approximating the
Recommended Dietary Allowances; without such supplementation they may be inadequate.
The extremely hypocaloric versions of VLCDs which are also often low in carbohydrate and sodium
promote a mild ketosis that gradually leads to a diuresis and rapid loss of weight in the first several
days on the diet.
Use:
Evaluation of general health and cardiac status is important prior to the institution of VLCD.
Physician monitoring during the regimen is also important. Many practitioners begin the regimen
with a 2-4 week LCD phase to assess ability to comply with a restrictive regimen and to begin the
weight loss process. This is followed by a 12-16 week VLCD phase; the regimen is limited to this
amount of time to avoid excessive loss of lean tissue. The VLCD phase is followed by a 4-6 week
refeeding phase of transitioning back to usual foods and gradually increasing caloric levels; this
helps to avoid rapid weight changes due to refeeding with restoration of glycogen stores and shifts
in water balance. The refeeding phase also provides a time for assisting the dieter to plan a
maintenance diet on conventional foods and to solidify a physical activity schedule. VLCD are most
effective when administered as part of a more general weight control program that includes
physical activity, nutrition education, behavioral modification and attention to decreasing other risk
factors. If additional weight loss is needed, it is recommended that several months elapse before
another VLCD phase is instituted.
Safety:
Minor physiological problems that occur even with appropriate physician monitoring of cardiac and
general health status include fatigue, dizziness (due to orthostatic hypotension), muscle cramps,
gastrointestinal distress, and cold intolerance. The risk of gallstones is increased, and seems to be
particularly high when weight loss is very rapid (e.g.>1.5 kg/week).
Effectiveness:
Because these VLCD diets are so low in energy, they usually produce a greater initial weight loss
than LCD; usually 10-25% over 12-16 weeks of treatment in randomized studies. They can
achieve 1.5 – 2.5 kg/week weight loss, with a total loss of as much as 20 kg over a 12 week period.
Levels of plasma uric acid and cholesterol tend to rise in many patients. Menstrual abnormalities
have frequently been observed. An increased tendency toward cholelithiasis (gallstone disease in
which the gallstones are abnormal, inorganic masses are formed in the gallbladder and in the
common bile or hepatic ducts) and cholecystitis (inflammation of the gallbladder because of
obstruction of the cystic duct from cholelithiasis) has been reported. The development of postural
hypotension is not uncommon.
 | |  | |  |
- Diet
Starvation
Fasting
Very Low Calorie Diet
Low Calorie Diet
Normal Calorie Diet
High Protein Low CHO Diet
High Fat Diet
Low Fat Diet
Beverly Hills Diet
High Fibre Diet
Grapefruit Diet
Fasting
Very Low Calorie Diet
Low Calorie Diet
Normal Calorie Diet
High Protein Low CHO Diet
High Fat Diet
Low Fat Diet
Beverly Hills Diet
High Fibre Diet
Grapefruit Diet
Proactol
Lipocerin
Chitosan
Biosculpt Night
Time Weight
Loss Formula
Conjugated
linoleic acid
(CLA)
Pyruvate
Lipocerin
Chitosan
Biosculpt Night
Time Weight
Loss Formula
Conjugated
linoleic acid
(CLA)
Pyruvate
Fat Burn
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